For dates of admission on or after April 15, 2017, Harvard Pilgrim is requiring notification from the servicing providers for non-routine newborn care (level II-IV) including all admissions to neonatal intensive care units (NICU). Notification is required within two business days of admission for babies whose care will be defined by the following nursery revenue codes:
- 0172 — Newborn Level II
- 0173 — Newborn Level III
- 0174 — Newborn Level IV
This requirement is applicable when a newborn is admitted to NICU immediately following delivery, is discharged from the hospital and then re-admitted, or transferred from the birth hospital to another hospital’s NICU.
The following information is required for notification of non-routine newborn care (level II-IV)/NICU services:
- Harvard Pilgrim identification number for the subscriber and/or newborn along with the member’s name
- Admitting provider’s name and National Provider Identifier number (NPI)
- Hospital’s name, location, and NPI
- Service requested
- Admission date (must be the actual date the newborn was admitted to inpatient status)
- Newborn’s date of birth
Submitting a notification
If the child has an active Harvard Pilgrim ID number, the servicing provider may submit notification to Harvard Pilgrim’s Referral/Authorization unit in one of three ways:
- electronically via HPHConnect or NEHEN
- by fax at 800-232-0816
- by phone at 800-708-4414
If the child does not have an active Harvard Pilgrim ID number yet, the hospital may only submit notification by fax or phone.
The Non-Routine Newborn Care (Level II-IV)/Neonatal Intensive Care Admission Notification Policy is similar to our Emergent Department/Urgent Admission Notification Policy, in that failure to provide adequate and timely notification will result in administrative denial of the claims. Harvard Pilgrim members cannot be held liable for claims denied for failure to notify.
For complete information, please refer to the new Non-Routine Newborn Care (Level II-IV)/Neonatal Intensive Care Admission Notification Policy, as well as the updated Notification Policy and Newborn Payment Policy in our online Provider Manual.